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The rescue of teenager Jonah Handler remains a picture of hope, following the collapse of the Champlain Towers South residential building in Surfside, north Miami, in the early hours of Thursday, June 24.
Firefighters managed to pull 15-year-old Jonah out of a bunch of twisted concrete and steel.
But the rubble rescue operations are so complex that only 12 people have been confirmed dead so far. 149 people are still missing.
Seven days after the tragedy, relatives cling to the hope that there are still survivors in the rubble.
In some cases, search operations are abandoned a week after a landslide or earthquake, if two days have passed without any rescue.
The rescue of teenager Jonah Handler has become a symbol of hope.
But there have been cases of victims who survived for much longer periods.
In May 2013, for example, a woman was pulled alive from the rubble 17 days after a factory collapsed in Bangladesh.
And after the 2010 earthquake in Haiti, which killed at least 200,000 people, a man was rescued after 12 days from the rubble of a store.
Oxygen and water
There are different factors that play a crucial role for a person to survive.
“In collapsed buildings between the cement or concrete slabs there will be gaps, spaces in which people can survive, and that explains why rescue teams continue their work, ”Mundo Ray Gray, who for three decades has been involved in rescues with the British NGO International Rescue Corps, told BBC.
Gray has been involved in earthquakes in Afghanistan, Iran, Honduras, and Colombia, among other countries.
Reshma Begum was rescued 17 days after the Rana Plaza factory in Bangladesh collapsed in 2013.
A key element is access to oxygen.
“Oxygen in general is generally not a problem in a collapsed building because the air finds its way in“said Gray.
The second essential factor is access to water.
“When a building collapses, fire alarms usually activate the water sprinklers. In the building, the gas and electricity supply will have been cut off to prevent explosions or fires, but the water supply will remain. because liquid may continue to drip from broken pipes. “
“I have participated in rescues where firefighters spray debris with water so that it can drip off and reach those trapped.”
Roberto Rubio is the founder of the NGO Salvamento, Ayudad y Rescate, SAR-NAVARRA-ESPAÑA (international aid entity), and has led rescues in the event of earthquakes and other disasters for two decades, in places like Haiti, Chile, Ecuador, Peru, Iran and Turkey.
Rubio told BBC Mundo that the factors that affect survival in these situations are unpredictable. “But like the rescuers there, hope cannot be lost until the end.”
“The main factor in the survival of a trapped person so that they can be rescued alive is undoubtedly the severity of injuriesBoth those that occur at the time of the collapse, as well as previous pathologies, ”said Rubio.
“In many situations, people saved alive after 10 days are young people with no previous pathologies of interest.”
A key factor is the severity of the injuries that may have occurred at the time of the collapse.
Besides access to oxygen and water, other factors to consider are “the permeability of the rubble, the quality of its fracture structure, which also affects both survival and rescue. For example, the morphology of plaques, large or small, clean or dusty. ”
Rubio added that temperature is a very important factor to take into account.
“This factor dramatically reduces the survival rate, causing the trapped person to dehydrate, but it is the temperature of the victim’s location that really makes the difference.”
“We can have an ambient temperature of 25 ° C in Miami, which apparently is not a good temperature, but the environment at the trapping site could be 20 ° C or less.
Crush syndrome
Even if a person is found alive, they can still face serious problems due to crush syndrome.
“Crush syndrome is necrosis or death of muscles due to compression from any cause, for example, a person who can get their leg stuck in an agricultural accident, or from a machine, or usually in a collapse, the typical example is an earthquake or the fall of a building, “Dr José Luis Górriz, president of the Valencian Society of Nephrology and head of the Clínico Universitario Hospital in Valencia, told BBC Mundo.
“Then when compressing the muscles, especially in the legs, ischemia occurs, they lack blood supply, inflammation occurs and this inflammation and lack of blood supply can lead to muscle death, death. cellular.”
The Champlain South Tours condo collapsed in the early hours of Thursday.
Cell death causes toxic substances to be released into the bloodstream, which can lead to two serious complications, noted Dr. Górriz.
“One is that fragments of a part of the muscle called myoglobin block the kidney tubules, as if they are obstructing the urine-forming ducts and this causes the patient to urinate less or stop urinating. So you have to unblock it in one way or another with droppers (physiological saline solution) or with fluids. ”
“Then when the cell becomes necrotic, the muscle cells and other cells, and 90% of the potassium it’s inside the cell, then it leaves the cell in the circulatory flow, in the blood, and there is a very large increase in potassium which can cause arrhythmia and death. ”
Rescue of survivors must therefore be extremely careful.
“You have to put drippers to increase the volume of infusion, increase the amount of blood in the vessels, so that it acts as a kind of unblocking.”
“If this kidney doesn’t recover immediately with droppers, it might need dialysis and may even end up with permanent kidney failure. In general, recovery by dropper or dialysis is usually associated with a good prognosis in the short to medium term if taken into account early.
“But then there is another problem that the doctors face and that is that when the patient is taken out of the rubble, there is a lot of additional danger, because when they take it out, all the substances that have been squeezed by the rubble are released into the blood and make a phenomenon of toxicity “.
“They have to come back again and again”
Gray says that due to the complexity of the rescue, it cannot be advanced quickly, or the risk of the debris endangering those trapped who may still be alive would be increased.
And it is essential that rescuers return to the same place several times.
“When we are looking for people and it is very hot we tend to find that during the day they fall asleep or are unconscious for periods. But at night when it is cooler, they wake up and that is why rescue teams are active at night. ”
“Rescuers must return to the same site over and over again to make sure they don’t fail to detect signs of a trapped person who was asleep or unconscious the first time they were there.”
Rescuers must move very slowly and return to the same place several times.
While finding survivors after several days can be extraordinary, such cases do happen.
Gray led the rescue of teenagers after an earthquake in Pakistan 15 years ago.
“The whole hill where the village was had collapsed, when we arrived a teacher told us that she heard voices. We managed to make a tunnel and after four hours we reached three teenagers from about 14 years old. ”
“They were in a hole, lying down, with little space, one of them, the one in the middle, was dead, but two of them survived more than four days under the rubble.”
“For me it was a mixture of immense joy and sadness at the same time, I would have liked to save the three living.”
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